How old were you when Trudeau declared “the state has no business in the bedrooms of the nation” and decriminalized anal sex? What about when HIV testing was freely available in your city? When Canada’s Supreme Court ruled in favour of gay marriage? When Macklemore’s top 40 hit, Same Love, became the Pride anthem for many this past summer?
While these questions may be a (not so) clever way of finding out someone’s age, within the health field, the answer to these questions can help to inform the kinds of services and information that are provided, and what approach a practitioner takes. There is increasing recognition that understanding experiences over the course of individuals’ and communities’ lives supports effective health policies, programs and interventions. These ideas are the foundation of the life course model.
The life course model is a “paradigm that recognizes the significance of history and cohort in human development” (Hammack et al., 2008). While some believe this just to be a common sense approach, the explicit adoption of a life course model impacts the development of health care systems and training for providers. Many scholars have argued for the absolute importance of using a life course approach to understand gay men’s experiences as communities and individuals.
The life course model recognizes that social and cultural environments impact the ways people come to understand and express their identities. Many authors, including Bertram Cohler, Phillip Hammack and Ritch Savin-Williams describe three (of many) distinct generations of gay men: those who came of age following World War II and found a hidden, subversive sexual identity, those who came of age following Stonewall during an emerging gay rights movement, and those who came of age in an era of organized resources and support groups for gay children and their families.
The ways people identify their sexuality has an impact on the avenues available for providing them with information. Some men who identify as gay, participate in gay-specific venues such as gay support groups and gay bars where health promoters can reach them with advertising and in-person events. It can be much harder for health promoters to reach men who have sex with men who don’t identify as gay or, who don’t feel comfortable or welcome in these gay-specific spaces. The life course model encourages us to think about how age and social climate impacts men’s decisions about how they identify and enact their identities.
The life course model also recognizes that individual experiences throughout life snowball to impact one’s health and well-being over time. For example, Ron Stall’s syndemic model (discussed here in January) shows how experiences throughout boyhood and adolescence can impact health outcomes in adulthood. This model shows that there is a pattern to many gay men’s individual stories, and these shared contextual factors at different points across their lives impact health.
At a population level, these individual life course experiences are part of the explanation for current patterns of health and disease (WHO, 2000). For example, the cohort of men who came of age following Stonewall also were the first to experience the impacts of HIV. Many of them experienced HIV as a significant, life-threatening health condition, observed significant numbers of people dying, community action to provide support, and political inaction. Many of these men are very well versed on HIV information, and are strong advocates of safer sex. In contrast, younger men who came of age following the introduction of effective HIV treatment may be less familiar with possible HIV-related impacts.
The services and supports needed by men from each cohorts are different: for example, older gay men may benefit strongly from bereavement-related support, whereas more appropriate supports for younger men may include education around HIV stigma and HIV prevention.
Some life course models focus on specific stages in a person’s life. The Institute of Medicine 2011 report on the state of LGBT health in the United States reported on childhood and adolescence, early and middle adulthood, and later adulthood. This approach highlights some of the issues that gay men may face developmentally and socially at different stages throughout their lives and encourages practitioners to respond to the changing needs of individuals.
Current life course work often focuses on a singular category and its possible impacts throughout one’s life. However, as discussed as part of the intersectionality blog in September, it is also crucial to account for more than just an individual’s sexual identity. Cohler and Hammack’s (2007) approach to life course work encourages men to tell their own stories, which certainly allows for the possibility of intersectional discussion.
The life course model provides a framework of what many of us involved in gay men’s health and communities observe: differences between men who grew up – and grow up – in different time periods. Cohler and Hammack discuss “cohort-defining events” that impact generations of gay men. For example, men who came of age during bathhouse raids, reparative therapy, and other surveillance have different health and support needs than those who have grown up with marriage equality, with online platforms for social and sexual networking with other gay men and without raids on gay bars and bathhouses. The life course model helps account for the impacts of significant and ongoing political and social change towards gay men on the lives and health of gay men.
Along with minority stress, intersectionality and a social ecologic perspective, the Institute of Medicine recommend a life course perspective in future LGBT health research. Life course approaches to gay men’s health help service providers, policy makers, researchers and others working in diverse communities of men to account for men’s cumulative lived experiences and tailor care, support and prevention to meet their needs.
A Life Course Approach to Health – World Health Organization http://www.who.int/ageing/publications/lifecourse/alc_lifecourse_training_en.pdf
Whose public health? An intersectional approach to sexual orientation, gender identity and the development of public health goals for Canada – Rainbow Health Network/Coalition for Lesbian and Gay Rights in Ontario http://www.rainbowhealthnetwork.ca/files/whose_public_health.pdf
The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding - Institute of Medicine http://www.nap.edu/catalog.php?record_id=13128
Phillip Hammack’s website: http://psychology.ucsc.edu/faculty/singleton.php?&singleton=true&cruz_id=hammack